<?
$VisitID = $_GET['VisitID'];

?>
<script language="JavaScript">



<!--element focus-->
function putFocus(formInst, elementInst) {
	if (document.forms.length > 0) {
  	document.forms[formInst].elements[elementInst].focus();
  }
}

<!--help provider-------->
function explain(name,output,msg) {
	newwin = window.open('','','top=150,left=150,width=325,height=300');
	if (!newwin.opener)
		newwin.opener = self;
	with (newwin.document)
	{
	open();
	write('<html>');
	write('<body onLoad="document.form.box.focus()" background="./images/10/main.jpg"><form name=form >' + msg + '');
	write('<p>You may enter your ' + name + ' here and it will be copied into the form for you.');
	write('<p><center>' + name + ':  <input type=text name=box size=10 onKeyUp=' + output + '=this.value>');
	write('<p><input type=button value="Click to close when finished" onClick=window.close()>');
	write('</center></form></body></html>');
	close();
  }
}



</script>

<?
//$visit = mysql_fetch_array(r_db("SELECT * FROM er_visit WHERE visit_id = '$VisitID'"));
?>

<form name=form method="POST" action="?page=submit_visit_add_page2">
<h1> Add Visit </h1>
<hr>

<table width="80%">
<tr>
	<td>Client Profile</td>
	<td>&nbsp;</td>
</tr>
<tr>
	<td>Presenting Issues</td>
	<td>&nbsp;</td>
</tr>
<tr>
	<td>1.</td>
	<td><input type="text" name="pres_is_1" size="80"></td>
</tr>
<tr>
	<td>2.</td>
	<td><input type="text" name="pres_is_2" size="80"></td>
</tr>
<tr>
	<td>3.</td>
	<td><input type="text" name="pres_is_3" size="80"></td>
</tr>
<tr>
	<td>4.</td>
	<td><input type="text" name="pres_is_4" size="80"></td>
</tr>

<tr>
	<td>Options Discussed</td>
	<td>&nbsp;</td>
</tr>
<tr>
	<td>1.</td>
	<td><input type="text" name="opt_1" size="80"></td>
</tr>
<tr>
	<td>2.</td>
	<td><input type="text" name="opt_2" size="80"></td>
</tr>
<tr>
	<td>3.</td>
	<td><input type="text" name="opt_3" size="80"></td>
</tr>
<tr>
	<td>4.</td>
	<td><input type="text" name="opt_4" size="80"></td>
</tr>
</table>



<table>
<tr>
<td>&nbsp;</td>
</tr>

<tr>
<td>Client Signature:
</td>
<td><input type="radio" value="Y" name="optClientSignature" checked>Yes
<input type="radio" value="N" name="optClientSignature">No</td>
</tr>

<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td>Time Taken: </td>
<td><input type="text" name="txtInterviewer" size="20" maxlength="50" onblur="changeCase(this)" onchange="remove_XS_whitespace(this)"></td>
</tr>


<tr>
<td>&nbsp;</td>
</tr>
<tr>
<td>Interviewer: </td>
<td><input type="text" name="txtInterviewer" size="20" maxlength="50" onblur="changeCase(this)" onchange="remove_XS_whitespace(this)"></td>
</tr>

</table>

<hr>

<TABLE width="100%">

<tr>

<td align="center">
	<input type=button value="Save" style="width:200px;"  onclick="verify();" name="btnSaveForm">
	<input type="hidden" name="selectedClientID" value="<? echo $ClientID; ?>">
</td>

</tr>

</TABLE>

</form>

</html>